,microscope.JPG 
Indiana Association 
of Pathologists, Inc.
Histology Laboratory, Indiana Medical History Museum 

October 2017

A 70-year-old female with a left upper eyelid lesion

Contributed by:



Mercia Gondim, MD, Neuropathology Fellow, IU School of Medicine

 Department of Pathology and Laboratory Medicine, 


and




Shaoxiong Chen, MD, PhD Assistant Professor, Indiana University School of Medicine

Department of Pathology and Laboratory Medicine

Clinical history:

The patient is a 70-year-old female who presented with left upper eyelid lesion over a few weeks. Her past medical history was remarkable for systemic arterial hypertension and conservative treatment for a left carotid aneurysm in the cavernous sinus.

An orbital computed tomography scan revealed a 0.6 x 0.5 cm enhancing ovoid nodule in the left superolateral preseptal soft tissues of the upper eyelid, which appeared to be separate from the bone and lacrimal gland. The radiological differential diagnosis included orbital lymphoma, granulomatous or inflammatory disease (Fig. 1).


Figure 1: Orbital CT with contrast demonstrating a solid homogenously enhancing lesion in the left upper eyelid (red arrows).

A biopsy was performed.

Gross examination:

One 0.9 cm irregular, tan-pink soft tissue was identified.

Microscopic examination:

Permanent hematoxylin and eosin (H&E) stained sections demonstrated a fibrotic lesion composed mostly of abundant thick collagen bundles, spindly cells, and atypical epithelioid cells with nuclear hyperchromatism and indistinct cell border. Occasionally the tumor cells were enlarged with prominent nucleoli. Particularly, tumor cells aligned in single rows were also noticed. (Fig. 2 and 3) The initial differential diagnoses possibly included neurofibroma and fibrohistiocytic tumors such as dermatofibroma and dermatofibrosarcoma protuberans.


Figure 2: The tumor is composed predominantly of thick collagen bundles, intermixed with columns and nests of cells. Fat and patchy chronic inflammation are observed in a focus. (H&E 40x)


Figure 3: Tumor cells present between thick collagen bundles. The cells are aligning and forming columns (file arrangement). (H&E 400x)

Immunohistochemical stains for S100, SOX-10, CD34, and Factor XIIIa were non-immunoreactive in the tumor cells. Other possibilities were considered after reviewing morphological features again. The tumor cells were immunoreactive for CKAE1/AE3, EMA, GATA3 and ER (Fig. 4).


Figure 4: The tumor cells are immunoreactive for EMA, AE1/AE3, GATA3 and estrogen receptor (ER). The immunohistochemical staining highlights the file arrangement of tumor cells.

October 2017 Final Diagnosis and Discussion


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